Do Substance Abuse Interventions Work Outside of Hollywood?

At some point during the academic year, it never fails that a student in our program will ask about Interventions as a tool or learning point.

This makes perfect sense as Interventions are so often depicted as a stereotypical drama in movies and reality TV. Some students even enter the program believing that Interventions are a best practice in the field.

The truth is: in my fifteen years as a counselor in the field, I’ve never seen an Intervention work outside of Hollywood.

Interventions are a paid service in which a clinical addiction professional facilitates a confrontational meeting with family and a substance-dependent family person. At this meeting, the family expresses the negative impact of the person’s addiction and related behaviors on them, individually and collectively. All members of the family seek to discontinue support and enabling, unless the person enters treatment immediately. The person in need of treatment is unaware of this meeting, or the involvement of the professional beforehand.

In the counseling program curriculum at CCE @ Assumption College, Interventions are reviewed as an option. However, professional experience has taught me and my colleagues that there are significant barriers to this service being effective for all parties involved: the family seeking support, the person in need of treatment, and the professional facilitator.

From a purely practical perspective, most of the clients and families that I’ve served have had state insurance (MassHealth) or have had their treatment funded by the Department of Public Health. Neither recognizes Interventions as a recovery tool that is worthy of reimbursement. They must be paid for privately— a major barrier for most families.

Working in multiple substance recovery settings (Detox, SOAP, Outpatient, Residential, Outreach) it has always held true that my colleagues and I meet the person in need of treatment before their family.

Our core principles as substance recovery counselors are to serve the person directly, empowering them with treatment options and resources for modifying their behavior. We must support the person in recovery to make positive changes in their life—at their own pace and without judgment or ultimatum. A dynamic that delivers an “…or else” ultimatum to the primary client promotes a perceived alliance of the counselor with the family, creating a barrier with the person most in need of the therapeutic relationship.

In a few cases, people can have sobriety forced on them, such as in prisons or institutions within the continuum of care. However, recovery as a lifestyle is an internal, personal choice that very few people can be leveraged into. Even in those rare cases, it almost never results in sustained engagement in pro-social and pro-sober lifestyles.

As counselors, we’re always mindful to respect a person’s right to choose and steer their own life, even when we do not professionally agree with the client’s choices.

Recovery is not a straight line. The perceived failures provide the person in recovery as much insight for their journey as their applauded achievements.

On occasion, we hear about “family only” or peer-facilitated meetings led by a person in recovery—not attended by a professional counselor— that inspire a substance-dependent family member to seek recovery. However, professional substance recovery counselors do not see themselves having a starring role within the Intervention treatment modality. Hollywood never shows what happens when Interventions go wrong, as they usually do.